Kidney function in diabetes with a functioning kidney transplant after subsequent transplantation of a whole pancreas or pancreas islets

Abstract

Abstract Background: Patients with diabetes end stage kidney disease may be transplanted with a live donor kidney or they may have a donor kidney from a deceased donor. In the latter case they may be offered a pancreas transplant along with the kidney transplant. Those who do not receive a pancreas together with the kidney may be offered a subsequent transplantation of pancreas or pancreas islets as treatment for the diabetes itself. A downside of such treatment is that the intensified immunosuppressive therapy may have adverse effect on kidney graft function. It is not known to what degree this represents a clinical problem. It is also grossly unknown whether the effects on kidney graft outcomes are different from islet or whole pancreas transplantation is given after successful kidney transplantation. The kidney function after pancreas or islets transplantation in these patients has not been systematically studied. Purpose: In this study the major task was to evaluate kidney function in diabetes patients who received a pancreas after a kidney transplant versus patients who received islet transplantation after a kidney transplant. Secondary we also studied patients who received a simultaneous kidney and pancreas transplantation. We focused on kidney function during the first month to evaluate acute kidney injury (AKI) and after 1 year for long-term follow up. We also recorded surgical complications to look at differences in these two groups. Methods: This study included 18 patients with either pancreas or islet transplant. We retrieved patient material from the Norwegian Renal Registry. Our data has been evaluated retrospectively and analysed by utilizing SPSS. Results: Our results showed no deaths among the 18 patients in the course of one year. Two pancreas patients ended up with graft loss. The incidence of AKI was higher in IAK than in PAK. Renal function was found to be stable in both groups based on eGFR measurements, one week after transplantation compared with the year after. Pancreas after kidney patients had more surgical complications compared to islets after kidney patients. Conclusion: Both islet and pancreas transplantation after kidney gave satisfactory results even though the results from the islet cell transplantation are not as good as in the original report by Shapiro et al. The high incidence of AKI in those receiving islet cells is worrying and challenges initiative to explore a less nephrotoxic immunosuppressive regimen for this patient group.